A. Field of the Invention
The present invention relates to a laparoscopic elevator to lift the abdominal cavity of a patient during laparoscopic surgery without gas, and more particularly, to a laparoscopic elevator to simultaneously lift the four quadrants of an abdominal cavity to perform laparoscopic surgery.
B. Description of the Related Art
Laparoscopic surgery has been greatly developed during the last decade mainly due to the fact that surgery is performed through minimal incisions, so that pain suffered by the patient and the postoperative recovery period considerably reduced, with the subsequent saving in disability time and suffering.
To perform this type of surgery it is required to make a space in the abdominal cavity of the patient in order to introduce both the optical catheter and the surgical instruments, in such a manner that it allows the separation of the organs and optical instruments from the visceral area to be treated and, at the same time, make the surgical tasks easier.
In the conventional laparoscopic surgery, the above referred abdominal space is achieved by inflating the abdominal cavity with gas under pressure, normally carbon dioxide, using very sophisticated and expensive apparatuses.
Such a technique presents anesthetic and physiological risks which may be mortal in nature. Serious and mortal damages have also been reported with the blind introduction of needles and surgical instruments, since they may cause an injury of the intestines and large pelvic vessels.
Laparoscopic surgery aided with the inflating gas also presents some inconveniences and important technical surgical difficulties, such as the fact that requires specialized instruments which are very expensive and difficult to handle since they have to be introduced through sleeves or tubular handles with valves including elements to maintain hermetic conditions in order to prevent the escape of the gas, and the instruments have to be adapted to the gauge of said sleeves. Furthermore, it is required that the sewing needles be straight to be introduced through the sleeves or handles, making their use difficult and defective.
Additionally, because of the characteristics of the instruments which are used, these are usually of the disposable type since they cannot be sterilized to be used in other patients.
Other instruments proposed to be used in laparoscopic surgery are described in U.S. Pat. Nos. 5,245,967, 5,390,644, and 5,271,385. Such instruments include straight flexible blades, held into a sleeve, normally for performing laparoscopic surgery with the aid of gas, whose unique function is to aid in the separation and holding of the intestines or organs, in order to "move them aside" during the surgery, but they are not suitable to lift the abdominal cavity.
A solution proposed to substitute the use of gas for making a space in the abdominal cavity for laparosocopic surgery, is to provide a hook, known as the "Maher Elevator" which is introduced through two small incisions made on the abdominal cavity, which is simply retained with a chain or string which goes to a pulley fixed onto the roof or onto an elevated position, in order to lift the abdomen, thus forming the needed interior space, such as is mentioned in the Article "Gasless Laparoscopy Useless or Useful?" published by David J. Hill, Peter J. Maher, and E. Carl Wood in the magazine The Journal of the American Association of Gynecological Laparoscopists, Volume 1, No. 3, dated May 3, 1994.
This hook provides an insufficient distention, since it is only introduced into a small length of the hemi-abdomen to be operated, and thus produces a limited space with a "utent-like" effect, insufficient for intestinal manipulation, instead of an ample space that is necessary to obtain a good visualization of the area to be operated.
Lastly, the most important advance to make a space enough in the abdominal cavity for performing laparoscopic surgery is represented by the apparatus developed by the company Origin Medsystems of Menlo Park, Calif., USA, named "Laparolift", cited in the previously mentioned publication and published in its pamphlet, that consists of two blades of diverse forms that are fixed to a holding element of an electro-mechanical elevating apparatus, and which are introduced into the abdominal cavity to lift one of the quadrants corresponding to that pair of blades, i.e., there is a pair of adapted blades to lift only one of the four quadrants.
Although such apparatus can be used to provide a space for laparoscopic surgery instead of using gas, it still has the disadvantage that requires a pair of blades to lift only one quadrant of the abdominal cavity, at the same time, providing again the "tent-like" effect which has as a result that the intestines and internal organs move filling the cavity made, thus making the surgery difficult. In addition, the blades of said apparatus are made of disposable materials and they cannot be sterilized. And last but not least, the arm that holds said apparatus cannot be sterilized because of its characteristics and for that reason it has to be covered with sleeves or plastic bags which are very poor regarding to their "sterile" requirements.
Concluding, for the laparoscopic surgery, it is absolutely necessary to provide an ample and enough space or cavity so that it is not invaded or filled with the patient's intestines or organs.
The laparoscopic elevator herein described provides such an ample abdominal space, cavity or distention, in a mechanical way, enough to perform the laparoscopic surgery with great efficiency and economy, allowing the use of the surgical instruments used in a conventional open abdominal surgery such as pliers, scissors, needle holders, sutures, etc., which provide great firmness and safety, eliminating the use of gas under pressure with all of the previously described inherent dangers, and avoiding the use of special and expensive surgical instruments and sleeves with valves to avoid deflation and preventing dangerous blind abdominal punctures.
The inventive concept of the present invention resides in providing a laparoscopic elevator to simultaneously lift the four quadrants of an abdominal cavity for laparoscopic surgery, having a cupola effect which provides an adequate visual space and room for intestinal mobilization and contention, which includes at least one lifting member for each quadrant, each of which is individually introduced in the abdominal cavity of a patient, and including: a horizontal lifting portion to lift the abdominal wall of a patient; a vertical flat holding portion at approximately 90 regarding the horizontal portion; and an elbow portion having an angular torsion to place the horizontal portion oriented towards one of the quadrants in respect to the horizontal portion of the first lifting member; and a holding handle that receives and holds each of the vertical portions of the lifting members and that is adapted to be coupled to an independent transmission arm that in turn is coupled to an electro-mechanical lifting apparatus. Such lifting apparatus is held to a suitable side of the operating table for lifting or lowering the abdominal cavity of a patient.
In addition to the advantages above described, this laparoscopic elevator has the additional advantage that, when the lifting members are introduced, one by one into the abdominal cavity of a patient, the optical catheter can be introduced with the first one, in order to observe the location of the first and subsequent introduced lifting members within the abdominal cavity, taking care that none internal organ whatsoever be squeezed, strangled or damaged, and simultaneously lift the four quadrants without having the "tent-like" effect, thus providing a sufficient and adequate space for performing surgery.
Also, because of the structure of the lifting members, of the handle and of the retaining arm, these can be manufactured from materials that can be sterilized (for example, stainless steel), and also those components which will be introduced into the patient, and everything that is used in the operative field, can be sterilized with gas, liquid or in an autoclave, without the need of using sleeves or plastic bags.
The contact surface of the five lifting members and their shape, increase the contact area with the abdominal peritoneum, which reduces the possibilities of a lesion by compression.
Due to the reduced gauge of the apparatus which is introduced into the patient, the sub-umbilical microlaparotomy can be of a reduced size.